Provider Demographics
NPI:1639236524
Name:STANTON, KELLEE N K (DDS)
Entity Type:Individual
Prefix:DR
First Name:KELLEE
Middle Name:N K
Last Name:STANTON
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1215 TOWN CENTRE DR STE 150
Mailing Address - Street 2:
Mailing Address - City:EAGAN
Mailing Address - State:MN
Mailing Address - Zip Code:55123-1033
Mailing Address - Country:US
Mailing Address - Phone:651-287-3729
Mailing Address - Fax:
Practice Address - Street 1:1215 TOWN CENTRE DR STE 150
Practice Address - Street 2:
Practice Address - City:EAGAN
Practice Address - State:MN
Practice Address - Zip Code:55123-1033
Practice Address - Country:US
Practice Address - Phone:651-287-3729
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-02
Last Update Date:2011-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MND11957122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN321818000Medicare ID - Type Unspecified